This case represents bilateral ovarian cyst with a different appearance on ultrasonography and MRI. On ultrasonography, the large one shows fluid content, however, with mildly altered echogenicity and the small right one is isoechoic. Ovarian cystic lesions with altered fluid content are considered complicated cysts and need further investigations, preferably with MRI.

T1 hyperintense cysts with no suppression at T1 fat sat are representing a hemorrhagic cyst differentiating it from mature cystic teratoma. The T2 criteria of the cysts are suggestive of chronic hemorrhagic cysts (ovarian endometriomas) with the T2 shading sign, seen on the left ovarian cyst, and complete hypointense signal as seen on the right one. T2 dark spot sign is also noted at both cysts and is considered a more specific sign for endometriomas than T2 shading sign ¹.